High-dose Anderson operation for nystagmus-related anomalous head turn

  • Michael GräfEmail author
  • Anja Hausmann
  • Birgit Lorenz



To evaluate the effectiveness of a high-dose Anderson procedure (AP) to correct infantile nystagmus–related anomalous head turn (HT).


Twenty-nine consecutive orthotropes with infantile nystagmus with and without associated sensory defect received high-dose AP. HT was measured while the patient tried to read letters at best-corrected visual acuity (BCVA) level at 5 m and 0.3 m. BCVA, binocular vision (BV), and alignment (prism and cover test) were measured. High-dose AP with recessions of 9–16 mm was performed. All measures were taken before and 3–6 and ≥ 8 months post surgery. Success was defined by postoperative HT ≤ 10°/HT ≤ 15°.


Medians and ranges (minimum-maximum) were:. Age at surgery was 7 years (4–44). HT at 5 m and HT at 0.3 m were 35° (20–40) and 20° (0–35), respectively. After 4 months (3–6), HT was 10° (− 3–20) and 5° (− 5–20); success rates were 74%/96% and 83%/96%. After 15 months (8–45), HT was 12° (0–20) and 6° (0–15); success rates were 46%/75% and 92%/100%; residual HT > 15° occurred in 5/9 cases with recessions < 13 mm and 1/15 cases with recessions ≥ 13 mm. With recessions ≥ 13 mm, 60% (95% confidence intervals (C.I.), 33–83%) achieved HT ≤ 10° and 93% (95% C.I. 66–99%) achieved HT ≤ 15°. Overcorrection did not occur. Anomalous head posture components in vertical and frontal planes did not improve. Residual motility was 30° (10–45). The mean BCVA improved by only 0.037 logMAR (p = 0.06). BV and ocular alignment were constant, except in 2 patients whose exophoria decompensated.


Kestenbaum surgery is a common procedure to correct infantile nystagmus–related HT. Anderson surgery is confined to bilateral yoke muscle recession; hence, less invasive but nevertheless comparably effective, high dosage is provided.


Anomalous head posture Anderson Kestenbaum Nystagmus surgery 


Compliance with ethical standards

Conflict of interest

All authors declare they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. The study was approved by the local institutional board of the Justus-Liebig-University (PN 130/15).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyJustus-Liebig-University GiessenGiessenGermany
  2. 2.Universitaetsklinikum Giessen and Marburg GmbHGiessenGermany

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